Skipping ahead as requested, on the different types of dementia…I have been able to find that there are many types or classifications of Dementia.There is: Frontal Lobe Dementia, Cortical Dementia, Subcortical Dementia, Alzheimer’s, PD dementia, Organic Dementia, Alcoholic Dementia, Multi-infarct Dementia and Normal-Pressure Hydrocephalus.

Frontal Lobe: those with frontal lobe have often had physical injury to the frontal lobe area. The frontal lobe involves major functions; emotions, sexual, problem solving, spontaneity, language, initiation, judgement and social issues. They often have intellectual function and no short-term memory loss. They do have inappropriate behavior that is frequently disinhibited. However in later stages, math or any type of calculation activity and finding similarities are often in the poor range. Regressive reflexes, most often found in infants (suck, grasp, gait, snout) also show up in latter stage.

Cortical Dementia: ... People with cortical dementia typically show severe memory loss and aphasia (the ability to understand language or express speech)or the inability to recall words and understand the spoken word. Cognitive functions such as language, praxis (process by which a theory, lesson, or skill is enacted) and visuospatial functions (estimation of distance and depth) can be impaired by diseases that affect the cortex, e.g., stroke, Alzheimer disease, frontotemporal dementia, diffuse Lewy body disease and Creutzfeldt-Jacob disease. Often these diseases affect other aspects of hemispheric function, such as memory (temporal lobe) and motivation (frontal lobes).Subcortical Dementia: Dementia with severe motor abnormalities, attention, concentration, improvement of memory(with prompting)As a side note: with PD, patients can and will co-exist with both cortical and subcortical dementia…will get into this farther laterAlzheimer’s: Dementia that effects memory, thinking, behavior, language, decision making, judgement and personality.

Parkinson’s Dementia: Dementia similar to Ahlzheimer’s, but occur out of order. Early in the course of Parkinson's disease dementia, mental slowing is seen along with mental inflexibility. Compared to people with Alzheimer's disease, those with Parkinson's disease dementia have somewhat worse visuospatial function, although at the early stages, this is usually demonstrated better by formal testing (such as the clock drawing task) than is seen in everyday life. Hallucinations are often seen in Parkinson's disease dementia. The hallucinations typically consist of seeing things that are not there. In Alzheimer's disease, hallucinations generally occur late (e.g. in the severe stage), but in Parkinson's Disease dementia, they usually occur early (when the dementia is in the mild stage. In fact, in Parkinson's disease dementia, hallucinations can be an early sign of dementia. Even when seen as a reaction to too much dopamine, they can be a sign of dementia to follow later.Symptoms that are more specific for Parkinson's Disease dementia are a mild memory impairment that at first responds to hints and cues. just as in Lewy Body dementia, patients with Parkinson's Disease dementia can show large changes in attention and alertness from day to day (one day they are able to hold conversation, next day the cannot). Other manifestations of fluctuation in symptoms are episodes of starring blankly, especially if it occurs to such an extent that you find yourself touching or even shaking the person you care for so that they will "snap out of it". Daytime sleepiness can be another sign of fluctuation. Sometimes, for reasons that are not clear, the fluctuation in alertness can be made better by making changes to medications that smooth out the level of dopamine.

Organic Dementia: Dementia that affects the limbic system with signs of hyposexuality, hyper-religiosity and paranoid psychosis. Usually if there has been damage to the hypothalamus, it will trigger; aggressive behavior and potentially changes in appetite for food and sex. If damage to the frontal lobe: left=depression, right=mania. Orbital damage can produce personality changes involving apathy or disinhibiting behavior. Caution with these disease involves checking for other issues( fever, incontinence, seizures, focal neurologic signs, regressive reflexes, movement disorders) as it may be prescription medication changes.

Alcohol Dementia: Chronic Alcoholics show deficits in frontal lobe function and can be reversed even at the severe levels, if the alcohol is removed from the body.

Multi-infarct Dementia: The result of multifocal small artery occlusive disease, they have a history of acute episodes of focal dysfunction. A progressive dementia in a person with appropriate risk factors for vascular disease (hypertension, smoking history, diabetes mellitus, hyperlipidemia, obesity, etc.) and the presence of focal dysfunction(s) on examination are strong support for the diagnosis. Magnetic resonance imaging (MRI) will show the typical bilateral multifocal small areas of attenuation deep in the hemispheres. Treatment consists of attending to the risk factors when possible. Anticoagulation with antiplatelet agents such as aspirin may be useful prophylaxis. The use of antithrombic agents (such as Coumadin) has not been proven effective outside of the setting of cardioembolism and may be too risky in a demented patient (due to increased chance of falling and hemorrhage). In the special case of the quite rare cerebral vasculitis, treatment may be able to arrest the underlying condition. Of course, preventing more strokes does not result in resolution of the dementia (although there may be some improvement due to compensation).

Normal-Pressure Hydrocephalus: This dementia is highly debatable and some say it doesn’t exist. According to those at Dartmouth it is highly complicated and even diagnosis is considered too stringent. It would take me hours to explain; it really has no bearing on PD, but, if you want to research it yourself, be my guest.

Now many of these dementias cross over each other and can co-exist with one another as in the PD dementia. I believe we could say as always…is it the disease…is it another disease… or is it the meds….. but at least in our case, I can’t narrow it down to one specific dementia. But dealing with it may be easier when you understand it a little better….

After posting this I went to get my mail and received an update to my Memory Bulletins from John Hopkins. In my next issues I will be receiving a "bulletin" called: "The 36-hour day" a special caregivers issue, can't wait for that....Also a note from them about Prescription drugs and your memory. They will be sending me a list of drugs that may impact memory.....that too should be quite interesting. This list will include OTC drugs and "movement disorder" meds.....wow...who'd a thunk it!!!!!!

It's funny(odd) too that they are also sending me a list of "natural" foods, vitamins and herbs that assist in memory and optimize brain function. Is the medical community finally realizing that there are "good" herbs and herbalists, besides all the quacks you hear about??? i shall see in that report.